Ultimate less invasive laparoscopic surgery by using needle devices and NOSE for rectal cancer

Objective of the study: The aim of this study is to develop a less invasive surgical technique by using needle devices and trans-rectal spec? imen extraction for patients with rectal tumors and to evaluate clinical results after the surgery.

Methods and procedures: In this study, we used needle graspers of 2 or 3 mm in size in performing laparoscopic surgery for rectal tumors. General laparoscopic anterior resection was performed by using these devices. Then rectal mucosa was washed out with clamping at the distal side of the primary tumor. Rectal wall was directory transected by electric cautery or the ultrasonic Harmonic Scalpel under laparoscope, with keeping 2 cm of distal margin at least. After an operator moving to anal side, we expand the anus by special retractor circumferentially and distal stump was sutured and closed from the anus. By pulling the suture, the specimen was removed per the rectal cut-end and anvil head was placed at the oral colon of the anastomotic site and push it back to the abdominal cavity. Rectal cut-end was closed in purse-string sutures from the anus. Reconstruction was performed by single stapling technique (SST) under laparoscopy. Five patients with rectal cancer and rectal carcinoid underwent this operation. We evaluate perioperative clinical outcomes after the operations.

Results: We had not experienced operative deaths in this study. R0 curative resections were done for all the patients. Median operation time was 270 min and amount of bleeding was 100 ml. There was one postoperative leakage in the first patient without diverting stoma and recovered conservatively without emergency operation. Greatest incision in this operation was less than 10 mm and the other incisions were 2 or 3 mm in size. Patients were satisfied with less pain and less abdominal incisionsafter this operation.

Conclusions based on the results: Laparoscopic surgery with needle use and trans-rectal specimen extraction is feasible and offer less invasiveness to patients with rectal tumors.